<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.12.02.03" title_num="10" subtitle_num="12" chapter_num="02" heading="Alleged Rape or Sexual Offense Victim Care.">
  <paragraph num="A.">
    <text>The victim shall be considered an emergency patient with special needs. The victim shall be taken immediately to a quiet private area where tests and examinations will be performed on the victim. The following measures are indicated under certain circumstances:</text>
    <paragraph num="(1)">
      <text>Prophylactic medication shall be discussed and offered to the victim who is at risk for pregnancy as a result of the alleged rape or sexual assault;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Prophylactic medication shall be discussed and offered to the victim who is at risk for sexually transmitted infections and recommended initial tests and follow-up tests shall be performed, if indicated;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>After the victim has been properly informed as to the significance of testing for the presence of the human immunodeficiency virus (HIV), the victim shall be referred to the appropriate anonymous or confidential, and free HIV counseling and test sites for potential baseline and follow-up testing and support services;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Injuries suffered by the victim shall be treated with appropriate consultation, as necessary; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Tetanus prophylaxis may be administered, if indicated.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Sexual Assault.</text>
    <paragraph num="(1)">
      <text>A sexual assault forensic examination shall be performed if:</text>
      <paragraph num="(a)">
        <text>The victim is seen within 120 hours of the alleged sexual offense; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Either:</text>
        <paragraph num="(i)">
          <text>A police report has been filed with the appropriate law enforcement jurisdiction; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A property-held number is assigned to the case in the event that a victim does not wish to file a police report immediately but still seeks to have evidence collected and held.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A sexual assault forensic examination shall be performed only by a:</text>
      <paragraph num="(a)">
        <text>Physician; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Forensic nurse examiner.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>When performing a sexual assault forensic examination, a physician or a forensic nurse examiner shall use the Maryland State Police victim sexual assault evidence collection kit or a comparable evidence collection kit and shall follow the kit instructions including:</text>
      <paragraph num="(a)">
        <text>Packaging the victim's clothing in paper bags; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Collecting the following specimens:</text>
        <paragraph num="(i)">
          <text>Blood sample (lavender cap);</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Vaginal swabs (a minimum of four);</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Oral swabs (a minimum of two);</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Pubic hair combings;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Pulled pubic hair;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Pulled head hair; and</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>If indicated, anal swabs, bite mark swabs, and fingernail scrapings.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>A physician or forensic nurse examiner shall follow the procedures as indicated to establish evidence of alleged rape or sexual offense, depending on the specifics of the crime as described by the victim:</text>
    <paragraph num="(1)">
      <text>Obtain from each of the following areas, if indicated, a smear to be fixed and stained according to the Papanicolaou technique:</text>
      <paragraph num="(a)">
        <text>Endocervical canal;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Vaginal pool;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Vulva;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Mouth; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Anal area;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Obtain culture for gonorrhea from cervix, rectum, and nasopharynx, if indicated, and plate it immediately;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Obtain vaginal, oral, or rectal aspirate for acid phosphatase testing, if indicated;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Obtain a blood sample for syphillis testing and refer patient to a healthcare provider of choice for repeat sample in 4 — 6 weeks;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Obtain X-rays necessary to establish evidence of physical injuries sustained as a direct result of the alleged rape or sexual offense; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Obtain either a urine sample or a blood sample for beta subunit of human chorionic gonadotropin for a pregnancy test and recommend and refer the victim to a healthcare provider of choice for a second test in 4—6 weeks, if indicated.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>A physician or forensic nurse examiner shall submit the evidence collected to the appropriate law enforcement jurisdiction.</text>
  </paragraph>
</regulation>